Wrong site surgery! How can we stop it?

"Primum non nocere" [first do no harm]: Hippocrates [c. 460 BC-377 BC]. Wrong site surgery is the fourth commonest sentinel event after patient suicide, operative and post-operative complications, and medication errors. Misinterpretation of the clinic letters or radiology reports is the commonest reason for the wrong site being marked before surgery. We analyzed 50 cases each of operations carried out on the kidney, ureter, and the testis. The side mentioned on clinic letters, the consent form, and radiology reports lists were also studied. The results were analyzed in detail to determine where the potential pitfalls were likely to arise. A total of 803 clinic letters from 150 cases were reviewed. The side of disease was not documented in 8.71% and five patients had the wrong side mentioned in one of their clinic letters. In the radiology reports, the side was not mentioned in three cases and it was reported wrongly in two patients. No wrong side was ever consented for and no wrong side surgery was performed. The side of surgery was not always indicated in clinic letter, theatre list, or the consent form despite the procedure being carried on a bilateral organ. As misinterpretation is a major cause of wrong side surgery, it is prudent that the side is mentioned every time in every clinic letter, consent form, and on the theatre list. The WHO surgical safety checklist has already been very effective in minimizing the wrong site surgery in the National Health Service

Thrombolytic therapy in acute myocardial infarction in Pakistan

To characterize features of acute myocardial infarction [AMI] in a Pakistani population, and assess the role of thrombolysis in our country, we studied 194 consecutive admitted patients with enzyme positive AMI. Males were affected three times more frequently; women, although affected less, had a higher incidence of complications than men. Premature coronary artery disease [CAD] was present in 50% patients presenting with AMI. An unusually high incidence of anterior wall myocardial infarction [39%] was seen. Complications were frequent with a predominance of LV failure symptoms. Cardiogenic shock was associated with a very high mortality, in excess of 93%. Streptokinase [SK] was administered in 60% patients with suspected transmural AMI. A statistically significant reduction in mortality was seen in the group that received SK [15.2%] compared to those who did not receive SK [24.7%], [p= < 0.05]

Anatomy of the human tricuspid valve

A study of the gross morphology of the tricuspid valve and its components Was undertaken in 43 human hearts uncomplicated by cardiopulmonary disease. Some variations in the anatomic features of the cusps, papillary muscles and chordae tendineae were found in this valve. These variations suggest a spectrum of normality in the tricuspid valve of human heart, at least in the Pakistani population. In the light of these findings, some of the terminology has been reviewed and re-defined

Conjoined twins: two unusual cases

Anomalies observed in two sets of conjoined twins on dissection have been described. The extent of malformation, besides being of academic interest, represents an aberration of the normal twinning phenomenon which needs to be recognized in early pregnancy. Further research is required to identify factors responsible for these anomalies